The Development of Sensor-Based Gait Training System for Locomotive Syndrome: The Effect of Real-Time Gait Feature Feedback on Gait Pattern During Treadmill Walking

Author(s):  
Hiroyuki Honda ◽  
Yoshiyuki Kobayashi ◽  
Akihiko Murai ◽  
Hiroshi Fujimoto
Author(s):  
Wei Liu ◽  
John Kovaleski ◽  
Marcus Hollis

Robotic assisted rehabilitation, taking advantage of neuroplasticity, has been shown to be helpful in regaining some degree of gait performance. Robot-applied movement along with voluntary efferent motor commands coordinated with the robot allows optimization of motion training. We present the design and characteristics of a novel foot-based 6-degree-of-freedom (DOF) robot-assisted gait training system where the limb trajectory mirrored the normal walking gait. The goal of this study was to compare robot-assisted gait to normal walking gait, where the limb moved independently without robotics. Motion analysis was used to record the three-dimensional kinematics of the right lower extremity. Walking motion data were determined and transferred to the robotic motion application software for inclusion in the robotic trials where the robot computer software was programmed to produce a gait pattern in the foot equivalent to the gait pattern recorded from the normal walking gait trial. Results demonstrated that ankle; knee and hip joint motions produced by the robot are consistent with the joint motions in walking gait. We believe that this control algorithm provides a rationale for use in future rehabilitation, targeting robot-assisted training in people with neuromuscular disabilities such as stroke.


2019 ◽  
Vol 19 (02) ◽  
pp. 1940018
Author(s):  
ANDY CHIEN ◽  
FU-HAN HSIEH ◽  
CHING HUANG ◽  
FEI-CHUN CHANG ◽  
NAI-HSIN MENG ◽  
...  

One-third of stroke survivors fail to regain independent ambulation and strokes have been identified as a significant source of long-term disability and a tremendous health burden. Robot-assisted gait rehabilitation is gaining traction and advocators for its inclusion as part of the routine post-stroke rehabilitation program are on the increase. However, despite the recent technological advances in the development and design of better robotics, the research evidence on the best model of robotic training remains sparse and unclear. It is therefore the aim of the current study to comparatively investigate the clinical feasibility and efficacy of a recently developed HIWIN Robotic Gait Training System (MRG-P100) combined with the use of a lab-developed MBS-E100 EMG system as a controller on facilitating the development of an appropriate gait pattern for motor impaired subacute stroke patients. The results indicated that due to the heterogeneity of stroke-induced changes in muscle characteristics, an “auto-fit” algorithm was required to allow constant monitoring and updating of the appropriate threshold based on EMG signals captured during previous gait cycle in order to determine the desired muscle activation threshold for the current gait cycle. Eighteen participants were tested using the new auto-fit algorithm and results demonstrated a significantly more fluent and physiologically appropriate gait pattern.


2020 ◽  
Vol 10 (12) ◽  
pp. 978
Author(s):  
Hanatsu Nagano ◽  
Catherine M. Said ◽  
Lisa James ◽  
Rezaul K. Begg

Hemiplegic stroke often impairs gait and increases falls risk during rehabilitation. Tripping is the leading cause of falls, but the risk can be reduced by increasing vertical swing foot clearance, particularly at the mid-swing phase event, minimum foot clearance (MFC). Based on previous reports, real-time biofeedback training may increase MFC. Six post-stroke individuals undertook eight biofeedback training sessions over a month, in which an infrared marker attached to the front part of the shoe was tracked in real-time, showing vertical swing foot motion on a monitor installed in front of the subject during treadmill walking. A target increased MFC range was determined, and participants were instructed to control their MFC within the safe range. Gait assessment was conducted three times: Baseline, Post-training and one month from the final biofeedback training session. In addition to MFC, step length, step width, double support time and foot contact angle were measured. After biofeedback training, increased MFC with a trend of reduced step-to-step variability was observed. Correlation analysis revealed that MFC height of the unaffected limb had interlinks with step length and ankle angle. In contrast, for the affected limb, step width variability and MFC height were positively correlated. The current pilot-study suggested that biofeedback gait training may reduce tripping falls for post-stroke individuals.


10.2196/13889 ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. e13889
Author(s):  
Kedar KV Mate ◽  
Ahmed Abou-Sharkh ◽  
José A Morais ◽  
Nancy E Mayo

Background Evidence shows that gait training in older adults is effective in improving the gait pattern, but the effects abate with cessation of training. During gait training, therapists use a number of verbal and visual cues to place the heel first when stepping. This simple strategy changes posture from stooped to upright, lengthens the stride, stimulates pelvic and trunk rotation, and facilitates arm swing. These principles guided the development of the Heel2Toe sensor that provides real-time auditory feedback for each good step, in which the heel strikes first. Objective This feasibility study aimed (1) to contribute evidence toward the feasibility and efficacy potential for home use of the Heel2Toe sensor that provides real-time feedback and (2) to estimate changes in gait parameters after five training sessions using the sensor. Methods A pre-post study included 5 training sessions over 2 weeks in the community on a purposive sample of six seniors. Proportion of good steps, angular velocity (AV) at each step, and cadence over a 2- minute period were assessed as was usability and experience. Results All gait parameters, proportion of good steps, AV, and duration of walking bouts improved. The coefficient of variation of AV decreased, indicating consistency of stepping. Conclusions Efficacy potential and feasibility of the Heel2Toe sensor were demonstrated.


2019 ◽  
Author(s):  
Kedar K.V. Mate ◽  
Ahmed Abou-Sharkh ◽  
José A. Morais ◽  
Nancy E. Mayo

BACKGROUND Evidence shows that gait training in older adults is effective in improving the gait pattern, but the effects abate with cessation of training. During gait training, therapists use a number of verbal and visual cues to place the heel first when stepping. This simple strategy changes posture from stooped to upright, lengthens the stride, stimulates pelvic and trunk rotation, and facilitates arm swing. These principles guided the development of the Heel2Toe sensor that provides real-time auditory feedback for each good step, in which the heel strikes first. OBJECTIVE This feasibility study aimed (1) to contribute evidence toward the feasibility and efficacy potential for home use of the Heel2Toe sensor that provides real-time feedback and (2) to estimate changes in gait parameters after five training sessions using the sensor. METHODS A pre-post study included 5 training sessions over 2 weeks in the community on a purposive sample of six seniors. Proportion of good steps, angular velocity (AV) at each step, and cadence over a 2- minute period were assessed as was usability and experience. RESULTS All gait parameters, proportion of good steps, AV, and duration of walking bouts improved. The coefficient of variation of AV decreased, indicating consistency of stepping. CONCLUSIONS Efficacy potential and feasibility of the Heel2Toe sensor were demonstrated.


2008 ◽  
Vol 2 (3) ◽  
Author(s):  
Zhiming Ji ◽  
Yazan Manna

Gait training is a major part of neurological rehabilitation. Robotic gait training systems provide paraplegic patients with consistent, labor-saving, and adjustable physical therapy over traditional manual trainings. However the high cost and social-technical concerns on safe operation currently limit their availability to only a few large rehabilitation institutions. This paper describes the synthesis of a linkage mechanism for gait pattern generation in a sagittal plane. The synthesis of the mechanism starts with the definition of a closed ankle trajectory obtained from normative gait data. The synthesis process we developed includes (1) construction of the desired ankle trajectory, (2) formulation of an objective function to be used for linkage optimization, (3) development of a procedure for transforming an initial guess to a starting set of design variables for optimization, and (4) development of a point-matching process needed for implementation. A set of stature-referenced parameters was successfully produced for a crank-rocker mechanism to generate the desired gait path. A simple linkage mechanism can be used as the pattern generator in a gait training system, and the presented process has been used to synthesize a linkage for a specific gait pattern.


2018 ◽  
Author(s):  
Rezaul Begg ◽  
Mary Galea ◽  
Lisa James ◽  
Tony Sparrow ◽  
Pazit Levinger ◽  
...  

Abstract Background: The risk of falling is significantly higher in people with chronic stroke and it is, therefore, important to design interventions to improve mobility and decrease falls risk. Minimum Toe Clearance (MTC) is the key gait cycle event for predicting tripping-falls because it occurs mid-swing during the walking cycle where forward velocity of the foot is maximum. High forward velocity coupled with low MTC increases the probability of unanticipated foot-ground contacts. Training procedures to increase toe-ground clearance (MTC) have potential, therefore, as a falls prevention intervention. The aim of this project is to determine whether augmented sensory information via real-time visual biofeedback during gait training can increase MTC. Methods: Participants will be over 18 years, have sustained a single stroke (ischaemic or hemorrhagic) at least 6 months previously, able to walk 50 metres independently and capable of informed consent. Using a secure web-based application (REDCap) 150 participants will be randomly assigned to either no-feedback (Control) or feedback (Experimental) groups, all will receive 10 sessions of treadmill training for up to 10 minutes at a self-selected speed over five to six weeks. The intervention group will receive real-time, visual biofeedback of MTC during training and will be asked to modify their gait pattern to match a required “target” criterion. Biofeedback is continuous for the first six sessions then progressively reduced (faded) across the remaining four sessions. Control participants will walk on the treadmill without biofeedback. Gait assessments are conducted at baseline, immediately following the final training session and then during follow-up, at 1, 3 and 6 months. The primary outcome measure is MTC. Monthly falls calendars will also be collected for 12 months from enrolment. Discussion: This project will evaluate the impact of augmented sensory information, via visually presented biofeedback, for improving gait function in people with stroke. This has implications for the rehabilitation of gait disorders following stroke and may have the potential to reduce falls in this population.


2020 ◽  
Vol 20 (10) ◽  
pp. 2040033
Author(s):  
BYUNG-WOO KO ◽  
WON-KYUNG SONG

This study investigated changes in gait symmetry with trunk displacement during phase-shifted auditory paced treadmill walking for effective training with auditory cueing provided in conventional gait training. Eighteen able-bodied participants walked at a comfortable speed on a treadmill and the measured cadence was set at 100% (baseline). The phase-shifted auditory cue was set to both phase advance and delay of 20% at 5% intervals based on the baseline with respect to matching foot contact to the auditory cue. Trunk displacement increased with the phase-shifted auditory cue, and the largest value was found in the 120% condition compared to baseline ([Formula: see text]). Step length, step time, and swing phase time symmetry ratio gradually increased with increasing phase delay and gradually decreased with increasing phase advance on the linear model. However, single support time and stance phase time symmetry ratio showed contrasting characteristics compared to above parameters. The results indicate that the phase-shifted auditory cue significantly changes gait symmetry and trunk displacement. Particularly, the 20% phase advance and delay cues yielded about a 5% change in the step length symmetry ratio. These results could be used to induce a symmetric gait pattern when an asymmetric gait appears in hemiplegia.


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